Patient acceptability of ctDNA testing in endometrial cancer follow-up

Objective: Circulating tumour DNA (ctDNA) is emerging as a potential option to detect disease recurrence in many cancer types however, ensuring patient acceptability of changing clinical practice and the introduction of new technology is paramount. This study aimed to explore womens opinions on the acceptability of ctDNA to monitor for endometrial cancer (EC) recurrence. Methods: Women enrolled on a non-intervention cohort study determining the ability of ctDNA to detect recurrent endometrial cancer were invited to participate in a semi-structured interview. Data was analysed using Template Analysis. Results: Eighteen women were interviewed. Participants represented a mix of cases, including early stage high-risk EC, metastatic disease at diagnosis and EC recurrence, to ensure a wide range of participant experiences were captured. A ctDNA blood test was viewed by participants as more physically and psychologically acceptable than clinical examination to monitor for EC recurrence. In particular, participants expressed overwhelming preference for a blood test rather than pelvic examination. Although participants acknowledged that an abnormal ctDNA result could cause anxiety, they expressed a preference to be informed of their results, even if a recurrence was too small to detect radiologically. Explanations for these opinions were a desire for certainty whether their cancer would recur or not, and knowledge would help them be more aware of symptoms that should be reported to their clinician. Conclusions: ctDNA monitoring to identify EC recurrence appears to be acceptable to patients, and for many, may be preferable to clinical examination.